When Life is Overwhelming and Therapists Don’t Get It

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If you didn’t believe life was difficult — well, you probably would have given up on this blog long ago. Some of us imitate Sisyphus, the mythical king sentenced to push a bolder up a hill for eternity. Each time he reached high enough, the rock rolled down and he started over.

A few therapists sell you a potential future far beyond anything realistic. They are usually young, naïve despite their years, or genetically disposed to walk on the sunny side of the street. A handful are just lucky. The imagined life on offer is like being next door to a barbecue: you watch the smoke and smell the meat cooking. Your portion, however, will be a plate containing the sizzle without the steak.

Bon appétit.

Other counselors attempt to persuade themselves of reasons to be optimistic. Their effort to salve your wounds also treats their own. Whether self-aware or not, they make noise in the office to mask the bone crunching going on just outside, the better not to hear the screams.

This month I came upon two bloggers who endure the piercing splinters from those broken bones. I did not say “have endured.” Their pain is still alive.

They don’t so much triumph over the travail as persist despite it. Each offers realism over fairy tales, honesty over imagination, and survival over happy endings. This is the brutal truth from their perspective.

Read their posts and weep, but remember, they are still around to speak to you, write for you, and live for themselves and those about whom they care. Each one offers a meaningful life, not a walk in the park. One is a Jack of many trades, the other a Jill of a teacher.

Both are enraged at those who maintain that “everything happens for a reason.” Each finds reasons — not a reason — to persevere despite the things they carry. They do not offer you all the details of what caused the suffering, preferring you to focus on the emotional consequences.

Consolation in life requires acknowledgement of the extent of the injury, not platitudinous minimization. Invalidation of your misfortune by a friend or counselor is the therapeutic equivalent of passing gas. Such people would tell you the end of Hamlet, with bodies littered everywhere, is just a part of the “divine plan.”

We benefit by the presence of a faithful soul who often can do no more than stand by. A good therapist offers this service, not the disrespect of telling you that Prince (or PrincessCharming is in the parking lot waiting for you.

The male blogger is an “adversity and life strategist:” Everything Doesn’t Happen for a Reason/

The lady is an English teacher: The Lottery/

Witness the pain of these writers. In so doing you will be honoring your own.

The photo is called Melancholy by Andrew Mason (London, UK). It is sourced from Wikimedia Commons.

Taking Yourself too Seriously and the Value of Going “Out of Your Mind”

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Right this second you are doing something worthwhile: you are not thinking about yourself.

There are usually better things to do than self-inspection. If the inward look were producing self-knowledge or healing, I’d encourage you. Too often, however, the rusty mind is just sawing wood for a building that will never be built. This is a ruinous misuse of sawdust.

We need time off from looking into the psychic house of mirrors we are trapped in: the head.

No one is the center of the world despite having been engineered to believe otherwise. Therein resides much unhappiness. Once one grasps this human design flaw, correction doesn’t require a factory recall. With a little tinkering, achieving a share of happiness becomes easier.

First, let’s define the dilemma, then address the remedies. Except for the golden few who view life as comic, we all suffer from it. As Thoreau wrote in Walden:

The mass of men lead lives of quiet desperation.

We are in solitary confinement, able to see only through our eyes, and hear the internal voice alone, save an occasional hallucination.8-)

Our life is all we have, and the one perspective we are born with. No hiding place is offered, nor a different vantage point. Every event is personal in its impact, however indifferent were the fates delivering it.

Without resilience, courage, and a capacity to deflect life’s arrows or ignore the pain, the internal questioning begins. Replaying the dead past endlessly does not generate happiness. The world’s hard knocks require a rebound: a return to the game. Weeks or months of self-preoccupation only exacerbate the wound.

I am not talking about real soul-searching or the best psychotherapy, either of which can untie the ropes binding us. Nor the torment of tragedy. Rather, endless rumination that is like running around a track until the path you’ve worn becomes a deepening trench leading in a circle.

How much do we matter, really? Are we worth the self-preoccupation? Might we not do better to spend time more productively, more joyously, more helpful to ourselves or others?

Our lives come and go. The world rotates without assistance. Will rejection by a potential mate be recorded in any history book? Will winning a promotion or losing a job influence the war in Syria?

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George Elliot wrote in Middlemarch:

It is an uneasy lot at best, to be what we call highly taught and yet not to enjoy it: to be present at this great spectacle of life and never to be liberated from a small hungry shivering self — never to be fully possessed by the glory (of the world) we behold, never to have our consciousness rapturously transformed into the vividness of a thought, the ardour of a passion, the energy of an action, but always to be scholarly and uninspired, ambitious and timid, scrupulous and dim-sighted.

Approximately 360,000 births occur daily and almost 152,000 deaths. It is a wonder newborns aren’t packed and delivered by the gross on a United Parcel Service truck. We are each too common. Few of us will be remembered, even as a footnote, in 100 years’ time.

The only one who gets marked in a memorable fashion is usually the person who holds the pen and writes on his internal self, a screen to which no one else has access. He marks himself and he mars himself.

Most of us can do better. No, this doesn’t mean we must accomplish wonderful things or produce famous children.

One should recognize that most events are “below the level of tragedy except (in) the passionate egoism of the sufferer,” (again, George Elliot’s words). We are no different from our fellow-man, who might cheer our escape from a too severe view of life, and benefit by a helping hand.

Do not be ashamed if you find yourself stuck on your own internal reflection. Nature made you so. How then to take yourself less seriously?

  • Sitting alone and inactive breeds claustrophobic thoughts the way a cesspool breeds mosquitos. Get out of the house.
  • Consider reading Lucretius, an Epicurean philosopher. Epicureans have gotten a bad rap, thought to be self-indulgent louts. They did prefer pleasure over pain, but applauded honor, as well. The Stoics, including Epictetus, Marcus Aurelius, and Seneca, are also worth attention. Their words, read as a regular discipline and reminder, may reduce feeling sorry for oneself.
  • Mindfulness meditation, if practiced daily, can put you in the moment and cut the strings to thoughts pulling you inside.
  • The Bible and other old religious texts reflect on the state of being human, even for the unfaithful. Of particular note are the “wisdom books” of the Hebrew Bible (The Old Testament): Job, Psalms, Proverbs, Ecclesiastes, and Song of Songs.
  • Consider public speaking (Toastmasters) and training in improvisation. The latter develops the ability to listen and react, not stay inside your head and generate what you should say in advance.
  • Generosity with time and money in ways small and large is a method for improving your mood, the well-being of the other, and increase your focus outside yourself.
  • Socialize and laugh.
  • Make a daily list of things you are grateful for.
  • More thinking about yourself will not solve the problem of over thinking about yourself!!! This might seem obvious, but many people stuck in endless ruminations reflexively turn to more internal cud-chewing as a solution to their dilemma.
  • Examine ACT (Acceptance and Commitment Therapy) instead. This form of treatment, unlike most types of cognitive behavioral healing, engages you less “in your head,” and more through non-linguistic means including acceptance, meditation, and action.

In the end, we come back to where we started: man is not the center of the universe, he only thinks so. To realize you’re not that important is both a curse and a blessing. The humility thereby produced will allow you to experiment on yourself rather than churn inside or cower in the shadows.

Unless you are capable of making history and enduring the cost of that worthy attempt, the possibility of less self-imposed unhappiness is available. Do your part, do your best — don’t do yourself in. A quiet mind can be enhanced by finding a humble place in the world.

Then, the next time someone says you are “out of your mind,” you will smile and say thank you.

The rabbit photo is called A Bunny Too Serious, by Laura Rantala. It is sourced from Wikimedia Commons.

Feeling Too Much or Too Little: The Emotional Tightrope in Life and Performance

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The charming 16-year-old could not watch the news. She was depressed, but not the victim of misfortune. Her parents had not mistreated her, life had not singled her out for unfairness. Rather, she was exquisitely sensitive to the pain of the human condition, to its terror — to the thousand little and big hurts, even those suffered by strangers. The news, with its roll-call of daily disaster, was unbearable.

All of this seemed in her nature, not her nurture.

For those of us not so fragile, there is a choice: how much of life do we let in (with its possibility of pleasure and risk of pain) and how much do we screen out to protect ourselves. Therapy patients, performers, and fictional characters display a range of answers. They are the subject of this essay.

The teen I mentioned was moved by art more than most, particularly those works that captured passing beauty and inevitable loss. The music of Mahler and late Schubert were on her list, along with the authors Virginia Woolf, Audrey Niffenegger, John Irving, and Julian Barnes.

Should this sound too sad, then I will tell you something else: the young woman was truly alive, not so numbed and deadened as the adamant stones that some of our fellow humans become. She perceived drama in commonplace events, while for most of the rest of us, those happenings pass unremarkably.

If we are lucky, our lives might be described as “balanced.” Our psychic doors are open enough to experience at least a partial glimpse of the dazzle and wonder of life, even if pain still finds entry points we hope to have limited to a degree. Indeed, in the music of Mahler and Schubert, my patient found both pleasure and pain.

Are most of us too defended against life and its inevitable disappointment and injury? By comparison to this troubled girl, do we risk a muted and gray existence? Does self-protection come at the cost of becoming unsympathetic to the misfortune around us and insensitive to the overwhelming sensuality of life, as well?

Princeton University psychologist Susan Fiske and her colleagues have evaluated something akin to these questions. Research participants reacted to a variety of photos. She and Lasana Harris predicted their experimental subjects would respond by dehumanizing extreme outgroups like the homeless. Pictures of those individuals produced a type of brain activation typical of disgust — the same kind of cerebral response characteristic of viewing objects, not people. Perhaps, unlike the sixteen-year-old mentioned before, some of us protect our emotions by responding to fellow humans as things. The evidence of history indicates disgust with such “Untermenschen” can lead to casual mistreatment and much worse.

A performance given by the storied English singer Kathleen Ferrier (seen in the newsreel above) and the conductor Bruno Walter illustrates part of our human dilemma: the tension between feeling too much or too little.

A 1947 Edinburgh Festival rendition of Gustav Mahler’s Das Lied von der Erde (The Song of the Earth) was the occasion. This hour-long song-symphony portrays the transient beauties of life and concludes in a 30 minute Abschied (Farewell), to a friend and to life itself, based on ancient Chinese poetry.

The work’s last moments are a whisper of exquisite, heart-rending beauty as the singer reflects on the fact that while human life passes away, the world itself will bloom anew in spring forever. The last word — “forever” or “eternally” (“ewig” in German) — recurs several times, more and more muted against the fading consolation of the orchestra.

According to Neville Cardus, a critic for the Manchester Guardian, Ferrier was “unable to enunciate (at least some of) the closing words.” Moved by the music, she broke down.

Ferrier would soon became a celebrated singer in a life shortened by cancer, but she was then new to this music and in awe of Bruno Walter, the 70-year-old conductor who had been the composer’s disciple and given the work its world première in 1911. Cardus tells the story of his arrival backstage after the curtain calls:

I took courage and forced my way into the artists’ room, where I introduced myself to this beauteous (unself-consciously beauteous) creature. As though she had known me all her life she said: ‘I have made a fool of myself, breaking down like that.’

When Walter came into the room she went to him, apologizing. He took her hands, saying: ‘My child, if we had all been artists like you, we should every one of us have broken down.’

For Cardus, it was one of the greatest, most life-changing performances he heard in a long career as a music critic.

Ferrier achieved this without every last word — the rare occasion when an artist triumphs over an important rule: to have emotional expression and emotional control, thus enabling the audience to experience the feelings without restraint.

It is ironic that to recreate emotions one must, to some degree, constrain them; never forgetting she is a singing actress playing a part and not her offstage self or a member of the audience. Ferrier’s failure to observe the rule caused her embarrassment, no matter the generosity of Bruno Walter’s consoling words.

Those of us who are not artists confront our own version of the same dilemma Ferrier faced: emotional control threatening to mute life’s music and dull its pleasures versus emotions undermining the ability to live, and leaving one unprotected from “The Heart-ache and the thousand Natural shocks that Flesh is heir to,” as Hamlet said.

In the theater, the dilemma is depicted in Peter Schaffer’s play Equus, where the audience exits the performance wondering whether the destructive, super-heated intensity of a teenager’s uncontrolled feelings are, perhaps, less a problem than the bound-up, dryly analytic, over-controlled existence of the psychiatrist who treats him.

The Original Poster for the German Film,

The Original Poster for the German Film, “The Lives of Others”

The 2006 Academy Award winning film, The Lives of Others, offers still another example. Gerd Wiesler, a Stasi (East German Secret Police) officer, begins the movie as a friendless man, deadened to everything except his duty. His superior gives him the task of monitoring a playwright. Closely observing the rich intellectual, social, and romantic life of this artist both enlightens the officer and opens up his emotions.

While Wiesler acquires this vulnerability at great cost, he also becomes capable of enlivened human contact and empathy.

What, then, are we left with in this consideration of human emotion?

Dyscontrol, routine. Intensity, flatness. Sentiment versus stoicism.

Over sensitive, insensitive. Excitability versus indifference. Empathy versus disgust.

Dazzled, dulled. Passionate, sterile. Open, closed. Vulnerable, safe.

Or walking the knife’s edge in between.

Your choice.

The first image includes Korean Hahoe Masks. The author is Julie and the photo was sourced from Wikimedia Commons.

Do You Have a Bad Attitude?

Life is difficult enough without making yourself miserable. Those who begin with a negative, “can’t do” point of view often justify themselves by saying that they don’t want to get their hopes up; that the world is unfair and one should be prepared for it. But in so doing they can create their own misery and bring down the mood of those who are close by.

I’ll discuss below a few variations on this theme — different forms of “bad attitude” along with some potential solutions:

1. Focusing on the past. While I am a firm believer in learning from the past, one must remember that it is yesterday’s news. Short of daydreaming about a happier time in your life or doing the essential work of grieving, it can fuel sadness without compensating benefits. The past holds too many unfulfilled hopes, failures, and broken romances. It is the storehouse of betrayals — about “what might have been.” It is the place where things that went wrong can fill your mind and heart with regret. It is a wasteland of missed opportunities, lost beauty, and a nostalgia that is no more satisfying than trying to fill your stomach with the photo of a past meal. Visit the past, but don’t live there.

2. Living in a frightening future. An exclusive focus on the future can be as deadly as a preoccupation with the past. The twin dangers of living in the future are worry/anxiety and make-believe daydreaming. Most who live in the future usually live a life of dread, overpredicting catastrophe and underestimating their ability to survive misfortune.

The only thing we have in life with any certainty is the present. Any chance of happiness depends upon one’s ability to find a way to live in the moment and find satisfaction there, experiencing it and whatever it brings, accepting life on its terms. Plan for the future but be careful not to live in that future any more than you live in the past.

The goal ahead might be very worthwhile, but try to enjoy the journey to get there. Mindfulness meditation, Stoic philosophy, the Zen tradition, and ACT (Acceptance and Commitment Therapy) can help reorient you to determining what is important in life; setting aside what is inessential, distracting, or worrisome; and living according to those principles in the present moment.

3. Pessimism or the self-fulfilling prophecy. Pessimism is a close cousin to worry and anxiety over events that may never happen. It smothers spontaneity, joy, and drains energy. It renders defeat in the game of life even before the game has begun. It anticipates a guilty verdict from the jury that causes one not even to show up for the trial. Pessimism destroys motivation and generates avoidance of challenges or half-hearted effort, at best. Depression and pessimism drink from the same poisoned well.

4. Throwing a wet blanket on the happiness of others. Don’t be a buzz-killer, a kill-joy, or a party pooper. Avoid raining on someone else’s parade. Don’t be an emotional suicide bomber, someone who brings down oneself and all those around you. A bad attitude can consist of always seeing the single dark cloud on a glorious sun-lit day, especially if the sun is shining on someone else. It is the “yes, but” response to the other’s good fortune, her excitement, and her dreams. It attempts to make others suffer as much as you are. This attitude masquerades as attempting to “be helpful” or “realistic” or trying to prevent the friend or child “from being hurt.” Perhaps. But it is a cautionary or negative/critical message at the wrong time, in the wrong place, to the wrong person.

5. Rejecting the encouragement or helpfulness of others. Most people want to ease your suffering, to offer you some encouragement or hope or solace. But if you have a bad attitude, you will reject all of this. You will say “I’ve thought of that already” when you are offered a suggestion or “I’ve already tried that” or “That won’t work because…” Instead, your bad attitude may isolate you from those who only wish to offer their presence and show their affection for you; their simple desire to hold your hand in a difficult moment. In the worst case you will drive such people away, thereby increasing your sense of separation from the world and guaranteeing a solitary misfortune.

6. Perfectionism or the belief that things can always be better. Some of us can’t accept a grade of 99% on the test, simply because we could have done better. Short of performing brain surgery, it is useful to be able to accept the imperfect nature of life and ourselves. Do your best, prepare for the race, study hard; but realize that perfection (if it is to be found at all) resides only in the works of Mozart, Rembrandt, Shakespeare, and a few others. If you punish yourself for falling short of that ideal, you have misunderstood the nature of life on earth and guaranteed that you will be joyless.

7. Whining and complaining. Worse than those who see only the dark side of life are those who not only see it, but won’t let you get away from them before they tell you about it in malcontented detail. They tend not to focus on abstractions. Rather, their concern is not the unfairness of life, but the unfairness of their life. There is no surer way of driving people away than to adopt this particular version of a bad attitude.

8. Fighting every battle. Some people seem perpetually aggrieved and angry. They live with a chip on each shoulder, daring life to knock the wood off. Life will knock it off, but not in the way that they expect. Their anger will breed anger in others. And in fighting perpetually, they will miss any sense of contentment or joy.

No one can take on all the battles worth joining, let alone those that will produce nothing of value. As an antidote to rage, gratitude for the things in life too easily taken for granted can be coupled with acceptance of the things that you can’t change. Ideally, these two abilities will usually counterbalance the frustrations and resentments of life without robbing you of the capacity to fight the good fight when necessary. Telling the difference between those skirmishes that need you and those you should pass is crucial. If you are too angry too often, seek counseling.

9. Refusing to take life seriously. If you’ve been paying attention, there is a relatively new popular expression among teens and a few others. It is called YOLO or “you only live once.” It justifies mindless foolishness; not just ill-considered behavior, but action that is not considered at all. It can be an excuse for doing whatever you want or refusing to do whatever someone else might advise. YOLO suggests that you are not living in the future, not living in the past, and not living in any really mindful present. If you were, the thought of driving 60 miles an hour down a side street in a school zone would never be translated into actually doing it. We seem to make enough mistakes in life without adopting a philosophy of life that virtually guarantees it.

10. Too much realism. While it helps to see the world as it is, there is the risk of it being too much of a good thing. The world as it is today (or most any day) includes poverty, genocide, and betrayal; infirmity, disease, and heartbreak; stress, cruelty, and the big one: death. Everyone you know will die and that also includes you. Focus on all of this just enough to make the most of your precious and too short life. Focus on it just a little more and you will be so depressed that you won’t want to get out of bed.

If you have any of the bad attitudes I’ve described, your first response will usually be to justify it; perhaps even to see it as a strength. But I would ask you if you are satisfied with your life as it is? If not, then you may need to investigate that same attitude, especially those aspects that actually could be making the problem worse. Ask friends and family what they see in you that needs to change — if they have enough courage and love of you to tell you the truth (and you have the guts to take it). Looking in the mirror — seeing yourself as others see you — is brutally hard, but can be a first step to enlightenment and a better life.

Read Czikszentmihalyi about “flow” and those wonderous moments when one is so involved in a productive/creative action that one loses all sense of time and self. Read Daniel Gilbert’s Stumbling on Happiness, Martin Seligman, Daniel Kahneman (Thinking Fast and Slow) and other “positive” (hedonic) psychologists about what makes for happiness and how to get there.

It can be helpful to make a list of those things for which you are grateful. Indeed, it may be of assistance to look back at the day to find what it can teach you or what was good (even on a bad day). Yes, I know that plenty that is bad does happen and has happened and will happen. But we humans must not live in these moments of misery for too long without grieving our losses and moving on, learning to accept the nature of life, and learning that the very best times are unreflecting, unself-conscious, utterly spontaneous experiences that we don’t think about, we simply are living them.

In part, our job is to pull our head out of its backward look, out of its forward glance, and play the game that is exactly where we are — right here, right now. That ultimately means more action, more experiment, more risk and less thought — swimming in the pool of life without regard to getting wet. It matters not if you start in the shallow end of the pool because most of us do — just don’t stay there.

Rear Admiral Grace Murray Harper knew more than a little about the water and about the voyage. She put the idea of living your life with a good (rather than a bad) attitude very well:

A ship in port is safe; but that is not what ships are built for. Sail out to sea and do new things.

The top image is Emotions X by Franz Xaver Messerschmidt (1736-1783) downloaded by access. The second is Messerschmidt’s The Constipated, dowloaded by Sailko. Both are sourced from Wikimedia Commons.

“I’m Still So in Love:” Why We Must Give Up the Ghost

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Some patients haunt your memory.

I recall treating a teenager who had lost her father suddenly.  It had actually been many years since he died, but she remained cut-off from the world and her family.

Friends were kept at a distance, her mother was pushed away, and her stepfather was never permitted to come close to her, try us he might.

Never ever.

Her mother and mom’s second husband worried about her self-isolation, so they brought her in to see me.

As the treatment progressed, I discovered that this young woman thought about her father a lot.

Every day.

She would review the memories that she still retained of his kindness and warmth.

Of course, I’d never met him, but I got the sense that she had idealized him — fashioned her memory so as to make him a vision of perfection that no flesh and blood mortal can hope to achieve.

And the recollected reproduction of her father, almost like a ghost, remained the most intimate connection of her life.

Not just historically, but even while I was treating her.

In fact, sometimes she would talk to him; one way, naturally, since she was not psychotic. And that provided her with a kind of closeness that was the best she could do to recreate the comfort that her dad had provided when this young woman was little.

As the protagonist states in Robert Anderson’s play I Never Sang For My Father, sometimes “death ends a life, but not a relationship.”

The people — the real people who reached out to my patient — found her unresponsive. They could not compare — could not compete — with the vanished flawlessness of her dad; an excellence that, after all, probably never existed in the first place, however dedicated and fine a man he might have been.

Moreover, her “relationship” with her father was safe: the dead cannot die on you; or reject you; or move away. They are utterly reliable and totally benign, unlike the rest of us.

As most of us do, my patient had been trying to protect herself from the injuries that life delivers from without, but left unguarded those equally tender places that are open to the wounds that come from within.

When a child loses a parent early on, she often loses the surviving parent, as well.

No, not to death, but to grief. Having lost a spouse, the surviving despondent parent (more often than not) is unavailable to aid the children. She is too bereft herself to be able to be the life-giving, supportive, attentive, omnipresent presence that children sometimes need a parent to be.

Worst of all, it is precisely at this time of loss that the child needs the surviving parent most desperately. And, it is at precisely this time that the remaining parent is least available and least capable of giving what he or she might wish to give, if only he or she could.

The result is a double-loss: one dead parent and another who is, for a time at least, a dead man walking, the half-alive state that we all know from the shock and privation and emptiness of a broken heart; a heart that one cannot imagine will ever heal.

It is no one’s fault, certainly not that of the grieving adult. Rather, this is just one of those dreadful ironies of the human condition: in the moment of loss and for some time after, the now-single parent has no capacity to do what must be done.

But the child needs that impossible thing, all the same.

Once I came to understand that my patient was still in a relationship with her father, her therapeutic needs became clear.

She needed to grieve the loss of her father to a satisfactory conclusion — a grieving that had been prevented by her fear of bringing up her own loss with her mother as much as her mother’s inability to console her child.

She needed to realize that she had put her life on hold by clinging to a ghost who, of course, could only provide so much warmth.

She needed to open herself to a stepfather who longed to engage her, even if he could not be the plaster saint her father had become; and the peers who were ready to provide their own rewards, even if they could not replace her dad.

The therapy worked out well.

My patient did not so much lose her relationship to her deceased father as let him go to a different place in her memory and in her heart.

It helped for her to answer the question, “What would your father want for you if only he could tell you?” Because the only answer he would have given (and she knew this) was that the beloved father of her dreams would want the best for her; and for her to reattach to life and to the people who could give her something that he could not.

After all, he was dead.

And so, she said goodbye to him. At last, she let him die.

So that, finally, she could live.

The photo above is of ectoplasmic mist at Union Cemetary, CT on 10/29/2004 by 2112guy, sourced from Wikimedia Commons.

“In Defeat, Defiance:” Suicide and the Danger of Giving Up Too Soon

When is suicide justified? When is it permissible to give in to the despair and hopelessness that life sends to some of us?

Before you answer, a cautionary tale.

The little girl was born in approximately 1889. She was five years old when her parents died in a home fire. Two older brothers, themselves only in their late teens, were now heads of a household that lacked a house.

The farming community in which they lived in Lithuania (then a part of Russia) offered few vocational prospects and certainly no way for them to support their two younger siblings. A neighboring family made them an offer. In return for the promised work services of the five-year old and the slightly older sister for the next seven years, the head of that family would advance the two boys enough money for passage to the USA. By then, it was hoped, the brothers would have sufficient funds to arrange for the transport overseas of their little sisters.

And thus, this poor little five-year old, already having lost her parents, now separated from the older brothers she loved.

What is seven years to a five-year old?

Eternity.

But the family with which these children lived was good to them, and the brothers made good on their promise. They kept in contact by writing letters to their sisters and, after seven years, had enough money to arrange for a reunion with them in the USA.

The now 12-year-old girl was named Johanna. And it was not too terribly long after, when she was 16, that she met the man who was to be her husband. Her brothers had been supporting her, as well as their own young families. It was time for her to marry, she was told. She had to choose among the suitors available in their small town of LaSalle, Illinois.

The man she chose was 16 years her senior — 32 years old. A coal miner. Farming and coal mining were the chief ways of making a living in that time and place.

Johanna had the first of her five children when she was 18. Life was relatively peaceful and she made the best of the marriage that her brothers had required of her. But, in her 37th year, Johanna began to feel less than her best. At first, she thought little of the fatigue and shortness of breath. Others noticed her pallor. Meanwhile, her appetite diminished and she suffered from diarrhea.

Eventually, the symptoms could not be ignored. The physician diagnosed her as having pernicious anemia, a disturbance in the formation of normal red blood cells.

There was no cure. Her doctor estimated that she might live for one year.

LaSalle, Illinois was a small, largely Lithuanian community. And in that place, at the same time that Johanna received her death sentence, so did another young woman, also a mother.

That person became profoundly depressed and hung herself.

Johanna did not. She did not want to leave her children and her husband in such a fashion. There were things yet to do for her children, messages to impart, care to deliver.

Johanna informed her children that she was going to die before long. She instructed them in what they needed to know in order to take over her household duties and become independent themselves. And, she told them that they would almost certainly have a step-mother eventually, and to welcome her as if she were their own mother.

In 1926, the year of her preparation for death, Johanna Grigalunas could not know that there would be a second World War 13 years in the future and that the country of her birth would be consumed by it. She might have heard of Winston Churchill, however, the man who became Prime Minister of England for most of that conflict. But she would not have been aware that Churchill battled depression himself.

Things were particularly dark for England in 1940. All of continental Europe had been conquered by the Nazis and night after night, the great cities of that island nation were bombed by the Luftwaffe, Hitler’s air force. The British Empire stood alone against the Third Reich and expected a land invasion. The United States had not yet entered the War and there was no certainty that it would. Virtually no one thought England would survive. But Churchill did and the Nazis were defeated.

In October of 1941, Churchill was asked to speak to the students of Harrow School, an independent boarding school that was his alma mater. Most of his words that day are now forgotten. But his job was to rally and inspire a nation, as well as the young men to whom he said:

“Never give in, never give in, never, never, never, in nothing, great or small, large or petty — never give in…”

Just as she could not know of the geo-political events ahead for the world, Johanna did not know that two separate research teams, one in England and one in the USA, were searching for a cure for the disease that afflicted her.

Thus, in 1926, George Richards Minot and William Perry Murphy fed large amounts of beef liver to their pernicious anemia patients, based on the pioneering work of George Whipple, who had demonstrated that the creation of red blood cells in dogs could be enhanced in this way. It was determined that a daily diet rich in liver would prolong the life of those with this disease. All three scientists received the 1934 Nobel Prize in medicine and physiology. Eventually, the crucial healing component in the liver, vitamin B 12, became deliverable by injection.

Johanna Grigalunas lived to be 93, more than a half-century beyond the medical death sentence that she received in the 1920s.

Now, you might ask, how is it that I know this story?

Well, I met Johanna Grigalunas, almost blind but full of life,  when she was over 90.

You see, Johanna was my wife’s grandmother.

The above image is of Winston Churchill. The quotation in the title is also from Churchill: “In war, resolution; in defeat, defiance; in victory, magnanimity.”

Churchill is reported to have suffered from depression off and on throughout his life. He referred to it as his “black dog.” On the subject of suicide, he said the following:

I don’t like standing near the edge of a platform when an express train is passing through. I like to stand right back and if possible get a pillar between me and the train. I don’t like to stand by the side of a ship and look down into the water. A second’s action would end everything. A few drops of desperation.


Two Americas, But Not the Two You Think

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Before his marital infidelity discredited him, John Edwards spoke eloquently about “two Americas.” He talked of differences between the health care, financial stability, education and housing available to these two different parts of our society.

But there is another American divide that has created two other Americas: on one side the fighting men and women in our armed services (along with their families) and the rest of us on the other.

If you are unhappy about the polarization of our society, look no further than the differences that have been institutionalized by the volunteer army. However much good was achieved by the decision to eliminate the military draft, surely the absence of shared sacrifice has contributed to the ease with which we take opposing positions to our fellow-citizens on matters that have to do with national security.

No longer does the USA pull together for the long haul in the way that was possible during World War II. In part, “the Good War” was good because enough people believed in the values for which the USA fought, knowing that their children, husbands, and brothers would defend those same values with their lives; and it was good because the people of this country (regardless of class) shared in the rationing of goods and the sheer terror of having their loved ones abroad and in harm’s way.

If a war is worth fighting, it should not have merit only because the children of other people are fighting it, even if they do so voluntarily.

These thoughts occurred to me as I listened (on CD) to the book Final Salute by Pulitzer Prize winning author Jim Sheeler. This book is about the officers who inform families that they have lost a loved one, and of the families who suffer the unspeakable pain of the death of a son, a husband, a wife, a brother, or a sister; a dad or a mom.

The book takes no sides on the question of the War in Iraq. Yes, you will hear occasional comments in support or opposition, but you will not think as much about these policy questions as about the human beings you meet along the way. Several families will become your acquaintances as well as the warriors — the Marines — who died serving our country. And you will also get to know Major Steve Beck, a Marine tasked to inform the families of their loss, the man who delivers a message nearly as shattering as the projectile that killed their loved one.

Major Beck and the Marines live by the creed that they shall leave no comrade behind. And, consistent with this value, Major Beck leaves no family behind, providing comfort and support long after the knock on their door that changes everything, that creates a “before and after” without end.

I wish I had the words to convey what is in this book. I don’t. But I can say that it is plainly written, eloquent in its simplicity, aching in its beauty, profound in its impact. It does not work to make melodrama of what is already poignant enough. Rest assured that you will think about war, any war, differently after reading or listening to Final Salute; unless, of course, you are a member of the “other America,” the one that fights the wars and sends its loved ones into conflict. If you belong to the bereft group within that group, then there is nothing contained in this book that you do not already know at a level too deep for words.

If you have lost just such a one as the young men portrayed in Final Salute, I can only give my condolences to you and your loved ones. It is thanks to the willingness of the few to serve on behalf of the many that the rest of us are safe.

We — those of us in the non-fighting America, those of us for whom the wars in Afghanistan and Iraq are abstractions — perhaps remain too comfortable, too detached from something of desperate importance: the work done far from home in our name by the children of other people. And too removed and distant from how these “best and brightest” of their families risk and sometimes give up everything they hold dear.

We need to remember that, for these families, the human cost never fully goes away.

They are out there, these inhabitants of “the other America.”

We walk by them unaware every day…

Kafka said that “a book is like an ax, to break the frozen sea within us.”

This is such a book.

The maps above are the work of Allstrak, courtesy of Wikimedia Commons.

The Upside of Depression and the Downside of Medication

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Are there advantages to being depressed? Something good about something we think of as so bad? A recent New York Times Magazine article by Jonah Lehrer makes just that case: Depression’s Upside.

The essence of the argument is that some episodes of depression allow for and encourage a kind of analytic rumination that is productive. Put another way, the tendency in depression to focus on a problem, mulling it over to the exclusion of other thoughts, permits the sad person to find a solution to his difficulty and change his life in a positive way.

The counter-argument, however, is that the ruminative process is both painful and unproductive — that it often creates a kind of self-flagellating preoccupation with one’s trouble rather than a process that leads to something good; that unhappiness and focusing on pain and its concomitants simply feed on themselves to no helpful end.

In my clinical experience, therapy with people who are depressed over loss or injury often breaks down into two phases. The first of these is a grieving process, where the person expresses and processes (or sometimes purges) the feelings of anger, sadness, emptiness, desolation, and hopelessness that come with the loss of something of value — a love, a job, high social status, a capability, a fortune, etc.

The second phase involves learning from one’s painful experience about how to live differently, make different decisions, associate with different people, become more assertive, overcome fear; value things differently in life such as money, material things, status, accomplishment, friendship, and love.

Naturally, neither of these two phases is absolutely discrete — they blend into each other and overlap each other. As a practical example, someone who has had a series of bad relationships will typically need to grieve the unhappy end of the most recent one and, in the process, learn how he happened to choose a person or persons who made him so miserable; then changing whatever needs to be changed internally and externally so that different and more satisfying choices occur in the future.

People who are like the hypothetical individual just cited usually come into therapy in emotional pain and seek relief of that pain as promptly as possible. This desire is entirely reasonable — who wouldn’t want this? Some of them request medication, which is often the fastest way to “feel better.”

But many are leery of psychotropic drugs and see them as artificial, hoping that therapy will produce a more lasting fix without dependency upon a foreign substance. Indeed, while a good therapist will strongly encourage the use of medication for someone who is seriously depressed, i.e. suicidal, unable to work, sleeping away the day away (or almost unable to sleep); that same therapist will also know that medication sometimes serves to “de-motivate” the patient, giving him or her a relatively quick solution that allows that person to tolerate an intolerable situation. In the New York Times Magazine article mentioned above, Dr. Andy Thomson describes this problem eloquently:

I remember one patient who came in and said she needed to reduce her dosage. I asked her if the antidepressants were working, and she said something I’ll never forget. ‘Yes, they’re working great. I feel so much better. But I’m still married to the same alcoholic son of a bitch. It’s just now he’s tolerable.’

Clearly, this woman was aware that she needed to be in some amount of discomfort in her relationship with her husband in order to be motivated to get out of it. The drug made her feel better, but, it also reduced her incentive to change herself and her life. It was, in effect, a kind of band-aid, rather than a real cure. It anesthetized her and, in so doing, robbed her of something that was essential for new learning and behavior change to occur.

Unfortunately, most people who come to therapy are neither as courageous or insightful as the woman just described. Once they feel significantly better, whether due to therapy or medication, it is common for them to be less interested in continuing treatment. They have recovered from the event that precipitated their entry into therapy, but they might not yet have learned enough to avoid making the same mistakes that contributed to the problem in the first place.

Such a person can reason that the cost of therapy (both financially and in terms of time, effort, and the difficulty that comes with changing one self) is now greater than emotional pain from which they might still be suffering. Put another way, at this point, doing therapy “causes” more difficulty and pain than not doing therapy, just the reverse of what seemed true when they started the treatment process.

At this stage, those who continue in therapy have something that an old mentor of mine, Truman Esau, used to call “therapeutic integrity.” What he saw in some of his patients was an almost heroic desire to make themselves better regardless of how much the actual process of doing so was difficult, uncomfortable, or painful.

These patients didn’t shy away from problematic truths about themselves or others. They worked hard to stretch and challenge themselves, knowing that it was crucial to improve. They didn’t simply want a quick fix. Like the woman in Dr. Thomson’s example, they recognized that some pain was essential to being motivated. They knew that there was no such thing as “a free lunch,” and were willing to do whatever it took to repair and better their lives.

If you are in therapy now, it will be important for you to be sensitive to this shift from the often intense distress that brought you into therapy, to the point when the therapy itself might seem distressful. This can mean that the therapist is not skillful or that he is pushing you too much, but it just might also signal that some of the most difficult life changes you need to make are still ahead of you, even if the cost of making those changes seems greater than when you started treatment.

If you leave therapy because it is hard and unpleasant work, the problems you have won’t care. They will simply continue to reside in you, work on you, and trip you up. It is not enough to get over your last disappointment or unhappiness, but to change yourself enough to avoid future problems.

Few things that are worthwhile come to us for free.

The above image titled Depression is the work of Hendrike, sourced from Wikimedia Commons.

Can You Sleep At Night? Being Ashamed and Feeling Guilty

There is an important distinction between being ashamed and feeling guilty. Both are connected to wrong doing, errors, mistakes, or failures. Both involve emotions. Feeling guilty, however, unlike being ashamed, doesn’t require an audience.

A person typically feels guilty almost automatically when he believes that he has done wrong. It matters not whether anyone else knows or finds out. Often, it doesn’t even matter that others might forgive the transgression. Thus, a sense of guilt is an internal state connected directly to an act thought to be wrong.

Shame, on the other hand, requires an audience, or at least, others’ knowledge of the inappropriate behavior or failure, even if they did not directly witness it.

By these definitions it is possible to feel guilty without being ashamed. One need only believe that one has done wrong. But someone who has been shamed (in other words, found out and condemned) might only come to feel bad if his behavior is widely known.

You might think that this always happens, but it doesn’t. Take the recently removed Governor of Illinois, Rod Blogojevich, who has yet to admit any guilt and who certainly doesn’t act ashamed; indeed, who appears quite shameless. Shamelessness is never a compliment, but rather a statement about someone who has no “shadow,” no sense of ever doing anything inappropriate.

To cite a couple of other examples, one a therapist and one a minister, neither felt guilty even after having their iniquity publicly exposed. In both cases the misbehavior was of a sexual nature that involved infidelity, as well as a violation of the code of ethics of their professions.

In the former case, the therapist had sex with ex-patients; in the latter example, the clergyman had sex with parishioners. Both were married (not to each other) at the time of these acts. The public exposure of their actions and ensuing humiliation mortified each of them and, indeed, each one contemplated suicide. But neither really believed what had happened was terribly wrong, and rationalized the transgressions in defense of his own self-image. In both cases the rationale involved holding the sexual partners largely responsible for the romantic encounters.

The connection between shame and suicidal depression is interesting and can be found even in the epics of Greek mythology. When Achilles died in battle, the Greeks held a vote to decide who among them should be awarded the splendid armor of Achilles, which had been fashioned by the god Hephaistos. Ajax (Aias) the Greater, the best warrior after Achilles, lost this competition to the cleverest of the Greeks, Odysseus, who had designed the Trojan Horse strategy that won the war. In his humiliation, Ajax went mad and eventually killed himself. Such is the devastating effect of a “loss of face.”

It should be said that the therapist and the minister I have referred to were quite narcissistic people who saw themselves through a very forgiving lens. Both terminated contact with old friends following their public embarrassment, in order to avoid facing them. In a sense, the self-love and lack of a well-developed conscience of the two people in question set the stage for their wrong doing — they believed that they were without moral flaws and therefore that anything they thought to do would automatically be a morally acceptable behavior.

Beware of those who say that they can sleep easily at night and use this standard as their primary method of judging or evaluating their own behavior. I doubt that the worst of the totalitarian rulers and despots of history would have failed this test of moral correctness, despite the murder, unhappiness, and genocide they created.

In the USA, on the political front, we have seen lots of people who don’t admit wrong, who rationalize what they do, and who serve themselves while claiming to be acting “on behalf of the American People.” I’m sure some of them come to believe their own story, their own rationale — shameless, as I said before; indeed, almost a kind of self-delusion.

In my experience, people who come to psychotherapy because they feel ashamed (but not particularly guilty) don’t usually take responsibility for their actions in the course of treatment. Rather, if the process follows the typical course, they will recover from the injury to their ego and be able to go on with life, still guarded against significant self-awareness. Moral self-reflection doesn’t seem to come easily or naturally to them.

By contrast, individuals who experience guilt that causes them to enter counseling often can learn to forgive themselves and recover from the depression that usually accompanies their guilt. For them, however, the risk is in taking too much responsibility and being too severe in their self-judgment, exactly the opposite of the person who is only ashamed.

It is useful to be capable of feeling guilt, to admit wrong doing, and to feel ashamed; that is, if one is to lead a moral life. On the other hand, it might be argued that those who are shameless and who rarely feel guilt probably have more fun in life and are less troubled — the mirror reflects their image back to them in the way that they want to see it, and not in the way it actually looks. They live in a state of ethical blindness. Whether that permits a satisfying life is another story.

You be the judge.

The above image is Shame by Libertinus Yomango, sourced from Wikimedia Commons.

How to Grieve, How to Live

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You might think that grieving is not an uplifting topic. But there are ways in which that is precisely what it is.

We start with the pain of loss, specifically a loss of something of value. If you lose a penny, you won’t much care. But if the loss is of something of great importance to you, you will care greatly. The pain of loss points to the value of the thing that you have lost; and the value you place on a thing points, at least potentially, to the pain to which you are vulnerable.

What are the things we value? A job, a relationship, friends and family, a promotion; our physical-self, which can be defaced or damaged… many things: money, status, a good name, a pet, and power, too. Take your pick. You decide what is important and whatever is inside the basket in which you put your emotional pain or your vulnerability to such pain — that item has value.

Grieving involves opening yourself to the pain. Now, you might think, “It must be only a recent loss that causes the hurt.” But the heart has no clock attached to it, no timer reading off the digits of distance between you and the loss; so, if you had a difficult childhood, you might still be holding the pain inside even though it is decades old.

Not only must you open yourself to the pain, but you must do it with a witness, a listener, someone who cares and who is present, who is “there for you.” This is necessary to reattach you to human contact — to life, to intimacy — rather than closing off and pulling away from people. And in this sharing — this openness, this talk and tears and gnashing of teeth — the pain eventually subsides. It’s a little bit like kneading dough — you continue to work it until it changes. The story of your feelings will be repeated by you, if necessary, dozens of times in different ways, until the emotions are changed and the excruciating intensity of the loss passes.

How long does this process take? Six months to a year would not be unusual, although it can be longer. The first anniversary of the loss is often especially hard; so are birthdays and holidays in the first year and sometimes beyond. But if you do not do the grieving “work,” the process can be extended and a sense of melancholy or a lack of vitality can follow you relentlessly.

To grieve doesn’t mean you will forget what you have lost. And, indeed, if it is a loved one, certainly you will never forget and you will never be untouched by the memory. There is a dignity in this. We honor the loved ones who are lost in this way and perhaps they live, metaphorically speaking, inside of us. As the Danes say, “to live in the hearts that you leave behind is not to die.”

But “how” to do this grieving — that is the problem. If you have lived your life trying to be tough, you will find that the toughness might prevent you from doing the emotional work that will allow the grief to end. If you maintain that “toughness,” you might find yourself living as if you are numb, or displaying a sunny disposition totally at odds with what is felt deep inside, in the place where you have buried your hurt. And if you have deadened yourself enough, you will have a hard time “living,” since you will be closed-off to feelings. Joy, abandon, and spontaneity will be harder to achieve. Instead, the time ahead of you would be better called “existence” than “life.”

But perhaps you are afraid that if you allow all the pain to come out, you will be overwhelmed to the point of being unable to function. And, indeed, this can happen, at least temporarily. Or perhaps you are afraid of what others might think of you if they see you without your typical emotional control, and you are afraid of their negative judgments.

And so, grieving involves having the emotions without the emotions having you; accepting them and not struggling with them; metaphorically speaking, it is like driving a car with the radio on, but not so loudly that you are overcome by it. In other words, you will have the emotions but still be able to drive — still be able to lead your life.

To do this you must open the pain in a place that is safe and in a way that it is neither deadened or perpetually out-of-control. You must hold the hurt not too tightly and not too loosely, but gently, since it is precious; not walling the emotions off or letting them carry you away from active life for days at a time. Part of this is simply allowing yourself to be human, to honor the injury, not judging or trying to change what you feel (the change will happen by itself if you allow it), but permitting yourself to do what our mammal relatives do — to lick your wounds (metaphorically speaking) and accept the support of others, whether they are friends, lovers, relatives, or therapists.

And, in the end, if you have grieved and have the courage, good luck, and time to continue the human project that we all have been given, you are likely to heal enough to venture forth into the world, again putting yourself into the things and people you hold dear, risking injury once more, not hiding from the dangers that life brings, but also experiencing what is good in life — all the things you still value.

You will be alive again, and the grieving process will have led you there.

The above image is The Grieving Parents, Kathe Kollwitz’s 1932 memorial to her son Peter, who died in World War I.